OTA president comments on research, treatment of blast injuries

As Dr. Andrew Schmidt, President of the Orthopedic Trauma Association (OTA) prepares to leave for Boston to attend a previously scheduled OTA meeting, his thoughts are with the victims who were injured from the April 15 explosions — as well as the trauma surgeons at Boston’s hospitals who are caring for them. Accounts indicate that improvised explosive devices (IEDs) caused the devastating blasts, because surgeons report that they were removing shrapnel, ball bearings, and other metallic material from the limbs of their patients.

“Bone and tissue are no match for materials projected from an IED,” explains Dr. Schmidt. “Blast injuries are extremely traumatic and cause complicated extremity injuries. Bone loss, muscle and nerve damage, and vascular injury are very common in these cases. Orthopedic surgeons must rely on every aspect of their training to salvage as much of the extremity as possible.”

Dr. Schmidt has seen firsthand the effects of these types of injuries and the damage they inflict when he volunteered at Landstuhl Regional Medical Center in Germany where military patients from Iraq and Afghanistan were transferred.

“Those IEDs were often packed with rocks, nuts, bolts and even animal manure, which made infection another complicating factor.”

Lessons learned from past military conflicts have always led to improvements in medical care. In recent years, extensive research sponsored by the Department of Defense for the purpose of studying battlefield injuries has helped improve care for injured military personnel, and that research is also applicable to civilian trauma.

“Our military colleagues have been facing these sorts of injuries every day for the past decade,” Dr. Schmidt points out. “The prevention and management of infection, compartment syndrome, and the combined reconstruction and rehabilitation of these mangled limbs has been a major effort of military medicine.”

Thanks to a novel research partnership sponsored by the Department of Defense, many civilian trauma centers – including those in Boston and Minneapolis – have been working with military surgeons to improve the care of these injuries.

As the patients in Boston recover from their injuries, they will have to go through extensive physical and occupational therapy; some of them having to learn to live with the loss of an extremity.

“What happens in a fleeting moment has lifetime consequences,” explains Dr. Schmidt. “This is a very difficult transition for many patients, and it can be a very long road. But thanks to advances in research, surgical care and prosthetics, there’s more hope than we’ve ever had before.”